Spinal Cord Injuries Centre, Royal National Orthopaedic Hospital, Stanmore, London, UK.
BJU Int. 2010 Nov;106(10):1510-3. doi: 10.1111/j.1464-410X.2010.09379.x.
To assess the long-term (20 years) effectiveness of the UroLume wallstent(TM) (Pfizer Inc., UK) in the treatment of detrusor external sphincter dyssynergia (DESD) in patients with spinal cord injury (SCI).
Twelve patients with quadriplegia secondary to SCI underwent external striated sphincter stenting with the UroLume wallstent in place of sphincterotomy for DESD ≈ 20 years ago. The mean (range) age was 41.8 (26-65) years. Eleven patients had cervical level injury whilst one had a thoracic injury. All the patients were shown to have high-pressure neurogenic detrusor overactivity and DESD with incomplete emptying on preoperative video-cystometrograms (VCMG).
Six of the 12 patients have now been followed-up for a mean (range) of 20 (19-21) years. Of the remaining six, two were lost to follow-up at 1 and 3 years, but both remained free of complications during that time. Two patients developed encrustation causing obstruction, requiring stent removal within 1 year of insertion. Another patient with an adequately functioning stent died 7 years after stent insertion from a chest infection. The twelfth patient developed bladder cancer 14 years after stent insertion and underwent cystectomy with urinary diversion. VCMG follow-up of the six patients showed a significantly sustained reduction of maximum detrusor pressure and duration of detrusor contraction at the 20-year follow-up. Five of these six patients developed bladder neck dyssynergia of varying degrees as shown on VCMG within the first 9 years of follow-up. All were successfully treated with bladder neck incision (BNI) where the last BNI needed was at 12 years. We did not encounter any problem with stent migration, urethral erosion, erectile dysfunction or autonomic dysreflexia.
Urethral stenting using the UroLume wallstent is effective in the management of DESD in patients with SCI and provides an acceptable long-term (20-year follow-up) alternative to sphincterotomy. The failures manifest within the first few years and can be managed easily with stent removal without any significant problems. Bladder neck dyssynergia was the long-term complication which was treated successfully with BNI. It has no significant interference with erectile function, being reversible, minimally invasive and has a shorter hospital stay.
评估 UroLume 壁支架（辉瑞公司，英国）在治疗脊髓损伤（SCI）患者逼尿肌外括约肌协同失调（DESD）中的长期（20 年）疗效。
12 例继发于 SCI 的四肢瘫痪患者在 20 年前接受了 UroLume 壁支架的外部横纹肌括约肌支架置入术，以替代括约肌切开术治疗 DESD。平均（范围）年龄为 41.8（26-65）岁。11 例患者为颈段损伤，1 例为胸段损伤。所有患者术前视频尿动力学检查（VCMG）均显示存在高压神经源性逼尿肌过度活动和 DESD 伴不完全排空。
12 例患者中有 6 例随访平均（范围）20（19-21）年。其余 6 例中，2 例分别在 1 年和 3 年时失访，但在此期间均无并发症。2 例发生结石形成引起的阻塞，支架置入后 1 年内需要取出支架。另一位支架置入 7 年后因胸部感染死亡的患者功能良好。第 12 例患者在支架置入 14 年后发生膀胱癌，并接受了膀胱切除术和尿流改道。6 例患者的 VCMG 随访显示，在 20 年的随访中，最大逼尿肌压力和逼尿肌收缩持续显著降低。其中 5 例在随访的前 9 年内出现不同程度的膀胱颈协同失调，VCMG 显示。所有患者均成功接受了膀胱颈切开术（BNI）治疗，最后一次 BNI 是在 12 年前。我们没有遇到支架迁移、尿道侵蚀、勃起功能障碍或自主反射障碍等问题。
UroLume 壁支架在脊髓损伤患者逼尿肌外括约肌协同失调的治疗中是有效的，为括约肌切开术提供了一种可接受的长期（20 年随访）替代方法。失败发生在最初几年内，可以通过简单地取出支架来处理，而不会产生任何重大问题。膀胱颈协同失调是长期并发症，通过 BNI 成功治疗。它对勃起功能没有明显干扰，具有可逆性、微创性和较短的住院时间。
